ETHTE# 09 -6'-eZ2778
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # ADDRESS :S-`l %lobc z 4n, rf oxcl .E yr ~ i/• 'r
NAME OF MOBILE HOME PARK OR S/D ;y
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION r rt t ~1~ ~ '`A' I ~w
The aforementioned site has been eva uat y t e am oun ea Depaent
Environmental Health Section.. At the time of lnspectionj there appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or '~qvk'o
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
c.+~
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date